The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
Department of Medicine, Jacob's School of Medicine, Buffalo, NY, USA.
Intern Emerg Med. 2021 Apr;16(3):633-642. doi: 10.1007/s11739-020-02469-y. Epub 2020 Aug 17.
Increasingly compelling data link chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) to cardiovascular complications independent of known comorbidities. It remains unclear whether the association is amplified in the presence of both conditions. The aims of this study are to assess the prevalence of atrial fibrillation (AF) in overlap syndrome (OS) and to identify risk factors predisposing to this atrial arrhythmia. We conducted a retrospective cohort study of 268 adults without past or current AF who were referred for an initial diagnostic polysomnogram from 2012 to 2019. A logistic regression analysis was performed to identify risk factors for incident AF. Incident AF occurred in 64 subjects [cumulative probability 24%, 95% confidence interval (CI) 19-29]. Independent predictors of incident AF were age-adjusted Charlson index [Odds ratio (OR) 1.62; 95% confidence interval (CI) 1.3-2.0], percentage of time spent with O saturation below 90% (CT90) (OR 3.72, 95% CI 1.18-11.71), and CPAP adherence (OR 0.32, 95% CI 0.13-0.71). OS patients with AF experienced higher hospitalization rates (OR 1.25, 95% CI 1.03-2.37) and worse mortality rates (OR 1.92, 95% CI 1.04-3.54). In multivariate Cox proportional regression, age-adjusted Charlson Index, severity of airflow obstruction, and CPAP adherence were independent predictors of mortality. The burden of hypoxemia and severity of comorbidities are independent factors for incident AF in individuals with OS. CPAP adherence may mitigate the risk of AF and reduce the rate of mortality in this population.
越来越多的证据表明，慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）与心血管并发症有关，且与已知的合并症无关。目前尚不清楚这两种疾病同时存在时，这种关联是否会加剧。本研究旨在评估重叠综合征（OS）中房颤（AF）的患病率，并确定导致这种房性心律失常的危险因素。我们对 2012 年至 2019 年间因首次诊断性多导睡眠图而就诊的 268 名无既往或现有 AF 病史的成年人进行了回顾性队列研究。采用逻辑回归分析识别 AF 事件的危险因素。64 例患者发生 AF 事件[累积概率 24%，95%置信区间（CI）19-29]。年龄调整 Charlson 指数（OR 1.62；95%CI 1.3-2.0）、90%氧饱和度以下时间百分比（CT90）（OR 3.72，95%CI 1.18-11.71）和 CPAP 依从性（OR 0.32，95%CI 0.13-0.71）是 AF 事件的独立预测因素。患有 AF 的 OS 患者的住院率更高（OR 1.25，95%CI 1.03-2.37），死亡率也更高（OR 1.92，95%CI 1.04-3.54）。多变量 Cox 比例风险回归分析显示，年龄调整 Charlson 指数、气流阻塞严重程度和 CPAP 依从性是死亡率的独立预测因素。低氧血症的负担和合并症的严重程度是 OS 患者发生 AF 的独立因素。CPAP 依从性可能降低该人群 AF 的风险并降低死亡率。
